Senior Claims Benefit Specialist

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates reputed company, sensitive, and/or specialized claims in accordance with claim processing guidelines.  Process provider refunds and returned checks. May handle customer service inquiries and problems.

• reputed company adjustments across reputed company dollar amount level on customer service platforms by using technical and claims processing expertise.
• Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply reputed company cost containment measures to assist in the claim adjudication process.
• Performs claim re-work calculations.
• Follow through completion of claim overpayments, underpayments, and any other irregularities.
• Process reputed company non-routine Provider Refunds and Returned Checks.
• Review and interpret medical contract language using provider reputed company to confirm whether a claim is overpaid to allocate refund checks.
• Handle telephone and written inquiries reputed company to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Ensures reputed company compliance requirements are satisfied and that reputed company payments are made following company practices and procedures.
• Review and handle relevant correspondences assigned to the team that may result in adjustment to claims.
• May provide job shadowing to lesser experience staff.
• Utilize reputed company resource materials to manage job responsibilities.

Required Qualifications

• 2+ years medical claim processing experience.
• Experience in a production environment.
• Demonstrated ability to handle multiple assignments competently, accurately, and reputed company.
• Effective communications, organizational, and interpersonal skills.

Preferred Qualifications

• DG system claims processing experience.
• Associate degree preferred.

Education

• High School Diploma or GED.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls.  The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above.   

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws.